The objective of our project is to evaluate an alternate approach to home care by a team of physician - NP (nurse pratitioner) - psycho-social support person, and to show that for many chronically and terminally ill patients this approach is more acceptable, more appropriately attuned to their needs and of lower cost than either conventional home care or institutional care. We expect to show that through this innovative approach to care there will be a decrease of acute episodes and complications requiring emergency room visits or hospitalizations in the projects' patients and we expect to show improved quality of life and psycho-social functioning at this critical phase of life. The operational aspect of the project is now being developed using existing agencies as a base for clinical care and recruitment of patients: the General Medicine Unit of the Dept. of Medicine, University of Rochester, and the Visiting Nurse Service (VNS) of Rochester and Monroe County, Monroe County Health Dept., Long Term Care Program, Inc., and Cancer Center of the University of Rochester. The present proposal requests support for the development of evaluative instruments and their use in a pilot group of patients. A hundred patients will be randomly assigned to either the Home Care Team or conventional care. They will be studied and compared as to cost and utilization of medical support services, quality of and satisfaction with rendered care. We foresee that the described Home Care program, if successful, will be expanded to include larger numbers of patient and several provider teams. A more extensive long-term evaluative project is contemplated for the future. This study should provide useful insights as to probable future dimensions of health care delivery mechanisms, including financial aspects.